People with mental illness falling through the cracks

This month, in response to the pressing need for more
supervised care, the Dunedin Night Shelter Trust, of which Mr
Brown is chairman, has opened Phoenix Lodge. The supervised,
rental accommodation takes ex-prisoners for three months,
giving them a stable, supportive place to live while they are
helped to reintegrate into society. But it has only six beds.

Today, with so many people with mental illness falling into
the criminal justice system, their health care, including
mental health, is split between the Department of
Corrections, which runs prisons, and the Ministry of Health
through district health boards (DHBs).

The department employs nurses and contracts others such as
dentists to provide primary health care. The DHBs run public
health promotion and preventive services such as communicable
disease control, as well as secondary and tertiary health
care including specialist mental-health services and alcohol
and drug services.

But problems and critics abound.

Even what would seem to be basic - effectively identifying
which prisoners have mental illness - has taken 13 years to
materialise.

In 1999, Corrections commissioned a report which for the
first time quantified the high rates of mental illness in New
Zealand prisons.

Compared with the general population, inmates are 23 times
more likely to have a schizophrenic disorder and 18 times as
likely to be suffering from post-traumatic stress disorder.
The stress disorder rates are 28 times more prevalent among
women in prison.

The report said the high level of need was "quite beyond the
capacity" of the prisoner mental-health services that then
existed. It called for a "significant increase in mental
health provision" and recommended screening techniques be
introduced to identify who had mental illness and to what
degree.

Eight years later a screening tool was given a trial, and
Corrections said although it wanted to implement it
nationwide the funds were not there to do so.

In June this year the department rolled out its mental-health
screening tool, which it said "lifts Corrections' ability to
detect mild or moderate mental illness in prisoners".

The department has been unable to say how effective the tool
has been since it was introduced.

Corrections' director of offender health Bronwyn Donaldson
said the department had made "significant progress" since the
1999 report.

All prisoners with significant health needs have a
health-treatment plan which can include, if needed, placement
and care in a forensic psychiatric facility.

Corrections worked closely with district health boards to
ensure the care prisoners received was "equivalent to that
provided in the community", she said.

But others disagree.

Two years ago the Ministry of Health's National Health
Committee said "service gaps are built into the [prison
health care] system and people cannot help but fall through"
both inside prison and when they are released.

The committee said its investigation had "raised the question
of whether any agency charged with custody can or should be a
health provider". It believed there was a "strong case for
transferring responsibility for prison primary health care
from the Department of Corrections to the health sector".

The call was repeated this year by Wellington-based Dr Paula
King, who said such a transfer of responsibilities had led to
better health care for prisoners in England, Wales, France,
Norway and several states in Australia.

Dr King said New Zealand's Child, Youth and Family service
handed responsibility for primary health care of its charges
to DHBs in 2009 and had since seen health outcomes
"significantly improved".

But as seems to be the way when it comes to prisoners, it is
unlikely to happen any time soon.

Minister of Corrections Anne Tolley and acting Minister of
Health Jo Goodhew both said they favoured the status quo.

At the same time, however, the call from various quarters to
effectively tackle the causes and repercussions of mental
illness among prisoners and former inmates is growing louder.

Kim Workman, executive director of Rethinking Crime and
Punishment, which promotes debate about the justice system
and alternative forms of punishment, says significant change
is needed if we want prisoners who, when they are released,
are not a burden on or danger to society.

A former head of the prison service, Mr Workman said an
article in the Otago Daily Times earlier this year
highlighting 23 murders committed by offenders on bail since
2006 had caught his attention.

He obtained the judges' notes on 20 of the cases, which
revealed "nearly all had mental health and drug and alcohol
issues", Wellington-based Mr Workman said.

"If someone had said 'Let's deal with the causes', some of
these murders could have been prevented.

"Our prisons have become de facto institutions for the
mentally ill ... and those with serious drug and alcohol
issues."

He wants to see more money spent on treatment and support of
prisoners and their families, greater investment in early
intervention drug and alcohol treatment, and a trial of
mental-health courts similar to the two drug and alcohol
courts opened in Auckland this month.

Pushing the cost of incarcerating and treating a prisoner
from $94,000 to more than $100,000 a year would save money in
the long-term, Mr Workman believes.

"We would be putting back in to the community a functioning
human who won't be a burden on society and instead would be a
productive member of it."

Equally concerned, but coming from a different perspective,
is Garth McVicar, spokesman of the Sensible Sentencing Trust,
which advocates policies it believes will reduce crime.

Napier-based Mr McVicar says his organisation wants the
number of psychiatric hospital beds increased and will be
calling for a government inquiry into the mental-health
system.

The number of police callouts that had a mental-health
component had risen from 6860 in 2002 to 10,734 in 2011. And
the number of acquittals due to insanity had risen 300% in
the past decade, he said.

In the meantime, while the poor mental-health of prisoners
and former inmates is not in anyone's interest, the
complexity and paucity of solutions remains, foremost, the
stark, moment-to-moment reality of those living under its
shadow.

When Vincent first got out of prison earlier this year he
wanted to go straight back inside.

"I admit I've been institutionalised," he said.

"It's in my comfort zone. I feel safe in there, locked away
where no-one can get at me." And without support on the
outside it is too easy to get into trouble again, he says.

"A lot, when they get out, say stuff it, I'm going to get on
the juice and drugs." But Vincent says he wants a future that
is "out of jail, crime-free and mentally well".

He has interests and aspirations. He quite enjoyed being a
cook in the Air Training Corps as a teenager. And he earned
some maritime certificates through Otago Polytechnic after
his time at Cherry Farm and before he "went off the rails".

Two weeks ago he moved into Phoenix Lodge.

"A friend of mine, he's there. He's doing well. We want to
help each other."

The individualities of each case make it difficult to know
who has the best stand point but this article certainly
summarises the situation well.
Interesting that in the first paragraph the author takes the
stance that the actions of the ill are "bad" in quotation
marks, inferring the actions aren't so bad. The actions are
actually bad without quotation marks. Bad is bad, even
if the people are not. Vincent's action of smashing the cars
was bad, even though he wasn't necessarily at fault due
mental illness. The judge was suitably lenient, I
think.
Nevertheless, cracks should be filled up and it's good to see
an article on the subject.